Healthcare Provider Details

I. General information

NPI: 1710278593
Provider Name (Legal Business Name): NATALIE SPICYN MD, MHS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 W LOMBARD ST
BALTIMORE MD
21201-1009
US

IV. Provider business mailing address

725 W LOMBARD ST
BALTIMORE MD
21201-1009
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-4091
  • Fax: 410-706-6422
Mailing address:
  • Phone: 410-706-4091
  • Fax: 410-706-6422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0632
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0632
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: